Making a Safety Plan for Migraine

We work with our doctors to create a treatment regimen including preventative and rescue options. Unfortunately, sometimes attacks don’t respond to these treatment plans and instead dramatically worsen, bringing us to our knees in severe pain that can last for days. Clarity of thought can be impaired by intractable migraine pain, dehydration, and exhaustion. In the face of this reality, a safety plan can help us address logistics; connect us to the support we need; and, ensure that we find resources to quiet intractable pain.

When should I create a safety plan?

We must create a safety plan when feeling well. It is not the time to consider how to handle an emergency when navigating severe pain. Many of us struggle with brain fog and aphasia (finding words and communicating with ease) during an attack. It is therefore all the more important to work out a detailed plan of action before we are in the throes of an intractable attack.

How can friends, family, and coworkers be involved?

Brainstorm who you can call for help with errands, and transportation to the doctor, pharmacy, or emergency room. If you want or need someone with you during high-level pain at home, it’s helpful to communicate this fact with those who are important in your life. Communicate with relevant friends, family members, or coworkers regarding your safety plan to ensure they understand what you need from them in advance.

I asked a trusted coworker if she would take me to the ER if I ever needed it. She knew I had migraine attacks. She agreed and just knowing I had someone I could count on set my mind at ease. The day came when I had to ask her to take me to the hospital. I was vomiting from the pain in the bathroom at work. I was so glad I could call on her as I didn’t have the energy to find a random person or feel guilty about pulling someone away from work. It was such a relief to know I could simply tap her and tell her it was time. She gathered me up and was so kind.

What role should your doctor play?

It is vital to create a safety plan with your doctor. This plan should include the steps to take if your preventative and rescue medication does not work. Do you have a back-up rescue treatment plan? Is your doctor’s office available for acute care during office hours? What about after hours? If not, who should you call? No one wants to go to the ER for a migraine attack. Does your doctor have other ways you could get care? Other medications s/he recommends you try?

How can you navigate or avoid the ER?

If your doctor recommends you go to the ER, what medications should you request? Could s/he write a treatment recommendation letter that you could bring with you? This may help cut through some red tape and potentially bypass the attitude that can be encountered by ER staff who assume migraine patients are drug seekers. If you go to the ER frequently, is your doctor willing to consider prescribing you a one-dose emergency medication to help you avoid the ER? Several options including Toradol can be administered at home. A steroid dose pack is another option for those who can tolerate it. Try to be as detailed as possible in creating this plan of action with your doctor.

I spoke with my doctor about a safety plan and I was surprised to learn that his office is open for emergency IV treatments during office hours. It’s not something they advertise so I was glad I asked. He also prescribed me a medication I can inject at home that helps to keep me from the ER (where I used to have to go 2-3 times a year). I haven’t been in over 5 years thanks to the safety plan I’ve made with my doctor.

Ultimately, creating a detailed safety plan in advance with our doctor, family, friends, and coworkers can help put us at ease as we face the many challenges that come with migraine.

Do you already have a safety plan? Have you asked friends, coworkers, or family members to help you? Let us know about times you have navigated intractable attacks. We look forward to learning from you in the comment section below.